Myocardial infarctions and strokes are dramatic events, both from a general and a personal point of view. Not only because they are the primary cause of death in the world, but also because their frequency is increasing. Their technological and pharmacological treatment involves a high economic cost, unavailable in many regions of the world.

From the epidemiological point of view, the importance of cardiovascular pathology is beyond doubt, it being the principal cause of mortality (Fig.1), not only in the developed world, but also progressively more so in less-developed countries and in those with intermediate economies.

 

Reasons

(prevalence in less-developed countries):

  • High levels of consumption of carbohydrates (which leads to obesity and its consequences), because they are cheaper.
  • The use of salt to preserve food (which leads to hypertension)
  • Tobacco companies are setting up in these less-developed countries.

In addition, it is predicted that the prevalence of cardiovascular illness will increase on a global level (Fig.2), due to the current obesity epidemic and its consequences, such as diabetes, changes in cholesterol levels (increase in LDL and decrease of HDL) and hypertension.

Despite the fact that cardiovascular illness is still the principal cause of death, the mortality associated with age has been decreasing over the last 25-30 years. Also, a large number of studies suggest that the reduction of risk factors and the treatment of the illness, once it has been detected, represent between 40-60% of this decrease. But, unless the incidence of the illness decreases at the same rate as its mortality rate, we will experience an increase in its prevalence over the next 20-30 years, a fact all too easy to predict.

 

Paradox

The prevalence of cardiovascular illness continues to increase, despite the reduction in mortality and big advances in technology and treatment.

The solution to this paradox is clear: Promote health and prevents cardivascular illness.

The economic burden that the treatment of cardiovascular illness represents is enormous, so it is more and more obvious in all sectors that, from an economic point of view, prevention is what we need to focus on

THE COST OF CARDIOVASCULAR ILLNESS

In a report produced by Humana Inc., the health costs generated by asymptomatic high-risk individuals, who had no history of cardiovascular illness, were analysed.

Some of these individuals suffered heart attacks or strokes, others did not.

The annual health costs for those individuals who did not suffer attacks of this kind started at 3,500 dollars and increased to 5,000 dollars over a period of three years.

The initial cost for those individuals who did have these kinds of attack was the same, but it increased to 20,000 dollars once they had suffered the kinds of attack mentioned above.


Fig 1. Forecast of deaths by cause in countries with high, middle and low income 2004, 2015, 2030
R. Beaglehole et. al. Lancet 2008;372:1988.

 

Fig. 2. Incidence and prevalence of coronary illness in the United Kingdom, 1996-2005.
(Am J Med. 2011 Challenges and opportunities for cardiovascular disease prevention. Franco M, Cooper RS, Bilal U, Fuster V)

 

Life expectancy and mortality of coronary patients in the United Kingdom, 1996-2005.
(Am J Med. 2011 Challenges and opportunities for cardiovascular disease prevention. Franco M, Cooper RS, Bilal U, Fuster V)

Conclusion

Analysts agree that over the next fifty years it will be impossible to cover the costs of treating cardiovascular pathologies with high technology procedures.

These same experts argue that the only way to combat this epidemic is through prevention and health promotion.

However, the main unresolved problem is the large proportion of the population destined to suffer a heart attack or stroke without being aware of the risks they are running.


Economic burden, prevalence and mortality in cardiovascular illness
(Fuster V, Mearns BM. The CVD paradox: mortality vs. prevalence. Nat Rev Cardiol. 2009 Nov;6(11):669.)